Post-endodontic pain following root canal treatment in permanent teeth among Indian paediatric patients

Pulp status in permanent teeth and post endodontic pain (PEP) has not been assessed properly in pediatric patients. Therefore, it is of interest to assess the prevalence, severity of PEP in permanent teeth after root canal therapy and retreatment in paediatric patients. Hence, 127 pediatric patients who had root canal therapy (RCT) for permanent teeth with necrotic pulp, vital pulporendodonticre treatment were considered. Assessment of incidence intensity of PEP at 6 hours and 18 hours after therapy was completed. The incidence and intensity of PEP in permanent teeth in paediatric patients was greater in teeth with vital pulp. It was low in teeth with necrotic pulp. The incidence of spontaneous PEP was greater in all treatment groups as compared to stimulated PEP at 6 hours after treatment. Thus, root canal therapy of teeth with viable pulp produced a noticeably greater incidence and intensity of PEP in permanent teeth in paediatric patients.


Background:
An essential component of endodontic therapy is the prevention and control of post endodontic pain (PEP) [1-3].Patients' perceptions of upcoming dental procedures can be improved, their pain tolerance can be raised, and the trust they have in their dentists can be bolstered by educating them about predicted PEP and providing drugs to control it [4-7].There has been research on the connection between the frequency and severity of flare-ups and the health of the restored teeth, but the findings have been mixed [8][9][10][11].According to study, flare-ups occurred more frequently in non-vital teeth following retreatment as well as endodontic treatment in comparison to vital teeth.Another study noted that tooth vitality had no bearing on the frequency or severity of flare-ups [12][13][14][15][16]. Pulp status and any PEP have not been observed to be correlated.After endodontic treatment, PEP (not just flare-ups) is highly common, and over 50% of patients who suffer PEP report having significant pain [17-19].However, no research has assessed the prevalence and seriousness of PEP in teeth with viable or necrotic pulp following initial RCT and subsequent retreatment [20][21][22][23].Therefore, it is of interest to assess the prevalence, severity, and kinds of post-endodontic periodontal disease (PEP) that emerge in permanent teeth with either necrotic or viable pulp following root canal therapy and following retreatment in paediatric patients.

Methods and Materials: Study population:
This is a prospective study of 127 paediatric patients who had root canal therapy (RCT) for permanent teeth with necrotic pulp vital pulp, or that were previously managed for symptomatic irreversible pulpitis, or whom had the root canal retreatment performed during the course of eight months by a single endodontic specialist.

Assessment of pulp vitality status:
Only in the cases where the tooth responded to a cold stimulus (CO2 snow) right before treatment and/or there was visible bleeding when the pulp chamber was opened was the pulp status assessed and documented as critical.If the pulp showed no reaction to cold and no signs of bleeding upon opening, it was considered non-vital.A periapical radiographic assessment was used to determine the state of periapical pathology.

Evaluation of post endodontic pain and use of analgesic drugs 24h postoperatively:
Within 24 hours after surgery, a student (MG), who was not informed of the treatments given, called the patients.She asked them to rate their pain using the same 1-5 point scale they witnessed when they completed the consent form, with 1 being no pain, 2 being light pain, 3 being moderate pain, 4 being severe pain, and 5 being very severe/unbearable agony, six and eighteen hours following treatment.Additionally, patients were asked to describe the kind of pain they were experiencing (spontaneous, triggered by mastication or palpation).

Statistical analysis:
For evaluating the continuous variables between groups, the independent student's t-test and one-or two-way variance test ©Biomedical Informatics (2024) Bioinformation 20(5): 571-574 (2024) 573 were employed.To compare the frequencies of categories of variables, the chi-square was employed.In cases where the probability was less than 0.05, differences were deemed significant.

Results:
The incidence and intensity of PEP in permanent teeth in paediatric patients was greater in teeth in which root canal therapy was conducted in teeth with vital pulp, while it was low in teeth with necrotic pulp at 6 hours and 18 hours after therapy (Table 1).The incidence of spontaneous PEP was greater in all treatment groups as compared to stimulated PEP at 6 hours after treatment.However, incidence of spontaneous PEP was lesser in teeth with vital pulp and teeth with necrotic pulp at 18 hours after treatment.Incidence of spontaneous PEP was however greater in teeth with retreatment at 18 hours after treatment (Table 2).

Conclusion:
Root canal therapy of teeth with viable pulp produced a noticeably greater incidence and intensity of PEP in permanent teeth among paediatric patients.Therefore, dentists should to be conscious of this discomfort during management.

Table 2 : Data regarding spontaneous PEP and stimulated PEP in different treatment groups at 6 hours and 18 hours after therapy Vital pulp
Studies on the association between the frequency and intensity of flare-ups and the state of the implanted teeth have been conducted, but the findings have been contradictory [16-24].In the current research, general practitioners managed teeth with clinical irreversible pulpitis by applying Ledermix to the pulp exposure location to reduce dental pain.It is known that the impact of anti-inflammatory drugs on the discomfort associated with teeth of this type [ [15][16][17][18][19]status of pulp-vital or necrotic-on the incidence and degree of severity of PEP[15][16][17][18][19].According to some studies PEP is more frequently seen after treatment of teeth containing live pulp.These findings are consistent with our own [21-25].

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When educating patients about anticipated pain and recommending medications for immediate consumption following endodontic treatment, doctors may find it helpful to pay attention to variations in the incidence and intensity of pain based on pulp state [11-15].To avoid worsening, alleviating pain should be an essential component of dental treatment, especially in the early phases.When determining whether to prescribe an analgesic, factors like the patient's gender, the number of therapy sessions, and previous encounters with pain as well as analgesics should all be taken into account [ ].A statistically substantial decrease in the occurrence of pain was observed by a research 24 hours after the intracanal anodyne corticosteroid was placed [20-25].Data shows higher PEP levels in women are consistent with studies conducted on other populations [12-17].Gender disparities in pain tolerance could be attributed to variations in men's bodies' responses to pain or to the stereotype that men can handle pain better than women [17-24].